本帖最后由 橙色雨丝 于 2017-6-23 14:57 编辑
瑞士卢加诺对于淋巴瘤病友来说是一个既神秘又神圣的地方，基本上没有谁去过但是却几乎都听说过。六月中旬，在那里召开的第14届国际淋巴瘤大会又传来了一些好消息，这里先分享一个关于滤泡性淋巴瘤的。
Prof. Massimo Federico from the University of Modena e Reggio Emilia, Modena, Italy, gave the second talk which discussed the risk of transformation in FL and the ARISTOTLE (Assessing the Risk of Transformation and Outcome of Follicular Lymphoma in the Immunochemotherapy Era) study.
来自意大利的专家在会上介绍了一项命名为“亚里士多德”的研究成果。（不得不说歪果仁真会玩，七拐八拐的就把一项很严肃的临床研究拼出了一个人人都知道的很好记的名字，佩服！）这项研究的主题是滤泡性淋巴瘤的转化风险和转归。
The study is based on clinical trials or Lymphoma registries collected by 10 different European Lymphoma Groups. The present study has a time frame of 1997–2013 using biopsy proven Histologic Transformation (HT) reports by the participating institutions, and in which transformation was diagnosed as the first event after initial therapy(regardless of whether patients had been managed expectantly at diagnosis ornot). The primary outcome measures are the cumulative risk of HT and Survival After Transformation (SAT).
研究的数据分别来自欧洲的十个淋巴瘤协作组所进行的临床试验和数据库，所取的时间范围是1997年到2013年，组织学转化必须是被活检证实的，而且必须是治疗后与首次复发时同时出现的，所以含义不同于一般所说的转化（包含未活检但是PET高度怀疑，多次复发后的转化）。
So far 9,172 cases have been referred and 7,405 (81% of potentially) are assessable for the main endpoint, i.e. the transformation risk. Patients were excluded due to transformed FL (tFL) at diagnosis (n=22),lack of date of diagnosis or relapse (n=49), diagnosis earlier then 1997 or later than 2013 (n=1,767; 19%), and other reasons (n=1,255). At time of diagnosis,patients had a median age of 58 years, and low, intermediate, and high riskFL-IPI of 30%, 34% and 37%, respectively. A total of 4,531 first events (61% ofassessable) were reported, 792 of which were confirmed by biopsy (17% of any event). Overall, 439 were classified as HT.
一共找到了9172个病例，符合要求的病例数是7405，中位年龄58岁，FLIPI风险分层高中低差不多各占三分之一。一共发生了4531个首次事件（复发或进展），其中792例进行了活检，439例证实为转化。
Initial treatment, as assessed in 7,335 patients, was Watch & Wait (W&W) in 941 patients (13%) and active treatment in 6,394 patients (87%).
七千多病例中，13%在确诊后进行了观察等待，其余87%进行了积极治疗。
The cumulative risk ofbiopsy proven HT as first event (n=413/7,335) at 5-years and 10-years was 5.5(95% CI, 5.0–6.1) and 7.1 (95% CI, 6.4–8.0), respectively. The incidence ratex1,000 people per year is 9.0 (95% CI, 8.2–9.9). Cumulative risk at 5-years and10-years in patients who had received active treatment was 5.3 and 6.7,compared to 7.4 and 10.4 in patients who underwent W&W (HR, 1.43; 95% CI,1.10–1.85; P =0.007). In patients who had not and had received rituximab, 5- and 10-yearcumulative risk was 7.2 and 8.9 compared to 4.8 and 6.2 (HR, 0.65; 95% CI,0.52–0.82; P <0.001).
首次复发或进展时出现活检证实的转化的累积风险，5年是5.5%，10年是7.1%，每千人每年是9%。（也就是说，一千位初治后缓解的滤泡性淋巴瘤病友，每年会有九位复发并且发生转化）一开始就积极治疗的转化风险分别是5.3%和6.7%，一开始观察等待的转化风险分别是7.2%和8.9%。（仍然不能证明积极治疗优于观察等待，因为根据其它临床研究，两者总生存率基本相当）用了美罗华后的转化风险分别是4.8%和6.2%，没有用的话则是7.2%和8.9%。
看图说话，上中下三条曲线分别是不用R，R+化疗，和R+化疗+R维持的转化风险，似乎R用的越多越好
After a median follow-up of 4.6 years, 191/439 events were reported. Median SAT was 32 months (95% CI, 24–46) and 5-year and 10-year rates were 41% (95% CI, 36–46) and 32% (95% CI, 25–38), respectively. 5-year SAT rate in patients whose transformation took place more than one year after diagnosis was 45% (95% CI, 38–81) compared to 34% (95% CI, 26–42) in patients who transformed in less than one year (HR, 1.64; 95% CI, 1.27–2.10; P < 0.001).
中位随访时间4.6年，发生转化后中位生存期32个月，5年和10年的生存率分别是41%和32%。如果转化发生在确诊一年之后，5年生存率是45%，如果不到一年就转化了，则是34%。
Federico concluded the talk by stating that the ARISTOTLE study, despite its retrospective nature, indicates that the use of rituximab significantly reduces the risk of HT as a first event. Treatment and management of tFL remains challenging, although the outcomes of patients in this analysis do not appear as poor as those reported in the literature.
结论是，美罗华的使用非常重要，可以显著降低转化的风险。转化后的治疗依然很困难，但是结局似乎并不像其它文献报道的那么差。
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